The Ethics of Egg Freezing – Yay or Nay?

Angela Hu, third year, looks at some of the issues surrounding the new technology of egg freezing.

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“As soon as I woke up in the recovery room, I no longer felt as though I were watching my window to have a baby close by the month. My future seemed full of possibility again.” – Sarah Elizabeth Richards, on why she chose to freeze her eggs at 36 years old (Richards, 2014).

Oocyte cryopreservation, or “egg freezing”, as it’s colloquially known, has been at the forefront of news lately, with Apple and Facebook announcing they would pay £12,000 towards the cost of egg freezing for their female employees, allowing them to focus on their careers (Barnett, 2014). And while egg freezing technology has been available for more than a decade, in the fall of 2012 the American Society for Reproductive Medicine officially removed its experimental label (Schubert, 2014), paving the way for more clinics to offer this service.

On the surface of it, egg freezing technology seems like a dream come true. To be able to preserve healthy embryos before our natural fertility starts declining, and wait to use them until we have found a suitable partner and are ready to have children; it seems like the pinnacle of reproductive technology. Especially to women in medicine, a demanding field often requiring more than a decade of training to become a fully qualified consultant, there is a delicate line that is drawn between waiting to have children and waiting too long, at which point it is no longer biologically viable to become pregnant. While egg freezing certainly is a field full of potential, there are still many ethical and physical implications that we must consider.

What is egg freezing?

The process of oocyte cryopreservation begins in the same way as in vitro fertilisation (IVF). The ovaries are hyper-stimulated with analogues of follicle-stimulating hormone (FSH), allowing them to release several oocytes during a single treatment cycle. Under mild sedation, the eggs are then retrieved by the doctor (NYU Fertility Centre, 2014). It is at this point where egg freezing differs from IVF; instead of being fertilized with sperm, the eggs are quickly frozen and stored, often for an indefinite time period.

There are two methods of freezing currently used – slow freezing and vitrification. Slow freezing involves using low levels of cryoprotectants, and slowly equibrilising the exchange of intracellular and extracellular fluids. To contrast, vitrification uses an extremely high cooling rate along with high levels of cryoprotectants in order to completely eliminate ice crystal formation. Current studies show that vitrification results in higher survival rates, less negative effects on embryo morphology, and improved clinical outcomes (Valojerdi et al., 2009).

Generally, egg freezing is performed for three main groups of patients. The first is cancer patients undergoing aggressive radiotherapy or chemotherapy, after which ovarian function may be significantly impaired. The second group is patients undergoing IVF, but who do not wish to freeze embryos, generally for ethical or religious reasons. And finally, the third group is for “social freezing”, in other words women who would like to have children at some point in the future, but who do not currently have a partner, or who wish to delay pregnancy for career, educational or other personal choices (ASRM, 2014).

Successes of treatment

The clinical pregnancy rate for embryos developed from vitrified oocytes was 38%, or about 60% when oocytes used were from donors. Another study showed that embryos developed from oocyte vitrification showed no difference in quality compared to those developed from fresh oocytes (Stoop et al., 2014). However, success rates greatly vary and are dependent on a number of factors – the age of the mother and therefore the quality of the eggs, the experience of the clinic, the freezing technology of the clinic, the number of embryos transferred into the uterus, etc. (Sherbahn, 2014).

The ability of the clinic itself to perform egg freezing leads onto another issue. There is currently no standardised, nationally recognised training programme or certification in oocyte cryopreservation beyond the training required to perform IVF, so it is unclear how to measure experience (Miller and Davis, 2014). Should clinics therefore be mandated to tell patients how experienced they are with oocyte cryopreservation technology? And if not, is the patient truly informed, or are they being misled?

Resource allocation

Many argue that being able to regulate when to have children without being burdened by our biological clock is giving women control over their careers, their families, and the direction of their lives. But at what cost? At a typical clinic in the UK, the process of egg collection, freezing and storage for three years is more than £3000. And if the woman should choose to store her eggs for longer than this period, it can cost hundreds of pounds for every extra year of storage (Boseley, 2014). In America, the cost of the egg freezing process can be more than double this. If the NHS decides to cover the costs of oocyte cryopreservation for women, like it does for IVF under certain conditions, is this simply adding an extra burden onto an already over-stretched health system? And is this fair when delaying reproduction is often a personal, not a medical, choice?

Of course, there are and always will be people who choose to undergo egg freezing privately, funding the procedure out of their own pockets. And while there are certainly many successes that arise from egg freezing and countless numbers of women thankful that this procedure exists, one cannot deny that it is an imposing financial burden on any woman, especially when a woman doesn’t know how long her eggs will need to be frozen for.

Risks of egg freezing

Even though egg freezing, like IVF, is generally safe, there are still associated risks. There is the potential of developing ovarian hyperstimulation syndrome (OHSS) from the fertility drugs, where the ovaries become swollen and painful and the woman develops abdominal pain, nausea, bloating and vomiting. Severe forms cause rapid weight gain and shortness of breath (Mayo Clinic, 2014). The retrieval of the eggs can also cause problems, ranging from bleeding, infection, or damage to various organs.

More than the physical risks, there is always the potential that false hope is being given. Even though egg freezing has shown the best success rates with eggs from young women (under 35), women currently choosing to undergo egg freezing are often in their late 30s. After spending time and a significant amount of money, it is reasonable that women would expect their efforts to yield a baby at the end of it all, but the reality of it is that there is still only roughly a 1 in 3 chance of becoming pregnant if the mother is under 40 (Mertes and Pennings, 2011).

Female power gives societal benefits

Advocates of egg freezing say that the procedure comes with a whole array of short and long-term benefits. Women who desperately want a child often experience high levels of anxiety and depression, and being able to have a child of their own greatly alleviates that distress. As for long-term benefits to the woman and society at large, according to Mertes and Pennings (2011) egg freezing enables increased gender equality; increased control over reproductive destiny; and more time to find a suitable partner, to complete education and to achieve financial and psychological stability before embarking on parenthood.

These are all greatly important in empowering women. In the past and even now, women have been greatly disadvantaged when it comes to job selection because many employers often fear that women will leave during their prime working years to have a child, and they will be forced to pay maternity leave. By leveling the playing field between men and women, women will be able to choose when to have children and thus control their careers as well as their personal lives to a greater extent.

Women who choose to undergo egg freezing are well aware of the issues that surround the procedure, including the fact that they will be at an older age when raising children. One could argue that being an older mother is unfair to the children as she will be less physically fit to take care of them, and this might be true to a certain extent (for instance if the woman is 70 when she has her first child). But for the average woman undergoing egg freezing, a few years of added age most likely won’t make a difference to the child, especially with our ever-increasing life expectancies. And with regards to the fact that many developed societies are currently falling under the natural rate needed to replace the population – 2.1 children per woman – egg freezing enables women who would otherwise have been unable to bear children to have a child, eventually increasing our workforce and benefiting our aging society as a whole (Boseley, 2014).

So what does Apple and Facebook’s decision really mean?

While Apple and Facebook’s decision can be applauded on many fronts, there are still issues that need to be addressed. It is unclear whether the companies’ packages include IVF, which would be required for egg freezing to even yield a baby. In which case the companies would effectively be paying for their female employees to stay “unpregnant”. Furthermore, while tech companies are often on the forefront of offering their employees the best benefits’ packages, that doesn’t mean that they cannot be improved. Currently, Google offers 18-22 weeks of paid maternity leave (Shontell, 2013), while Apple recently increased their maternity leave to 4 weeks before delivery and 14 weeks afterwards (Lev-Ram, 2014). The United States does not offer financial support for mothers, so in comparison Google and Apple can be seen as quite generous. But contrasted to countries such as Sweden, where women have 420 days of maternity leave and are paid 80% of their normal wages (Huffington Post Canada, 2012), the compensation seems rather paltry.

Additionally, this new compensation package may pressure women into freezing their eggs for fear of “missing out”, even when the choice might not be suitable for them. These women might feel obligated to freeze their eggs even if they are not sure they wish to have children, undergoing expensive and time-consuming procedures for the sake of fulfilling society’s expectations that women should become mothers.

What all companies, not just Facebook and Apple, should really be doing is providing more inclusive and family-friendly packages. This may or may not include egg freezing, but there should be the option of having subsidised daycare costs, increased paternal leave, more flexible working hours, and support for re-entry into the workforce (Baylis, 2014). In this way, all women who choose to have children, whether naturally or via alternative conception methods, will have good support and won’t need to make the choice between their career or their family.

Conclusion

Having explored all of these important issues, the allure of having control over our reproductive timeline, something that was once thought to be set and unalterable, wins out in many women’s minds. At the same time, egg freezing is still new technology and needs to be carefully researched and monitored in the coming years. It is not a decision to be taken lightly, and greatly depends on the woman’s personal circumstances. If egg freezing does eventually become the norm, the costs should be lowered so that it can be accessible to everyone, not only the privileged. It remains to be seen whether or not one of the final frontiers limiting women – our biological clock – can be overcome by this exciting new field.